Can we find keys to the future in the wisdom of the past? Unravelling complexity to tackle modern urban health challenges.

A briefing for professionals and policy makers in the fields of public health, housing, transport, urban planning and social welfare, as well as those responsible for their education and training. Individuals and institutions involved in the management, maintenance and planning of buildings, public spaces, urban infrastructure and services.

Urban leadership needs strengthening if we are to support people’s health. We all know that cities are marked by complexity. But, if ignored, this all to often leads to unintended negative health consequences from even seemingly straightforward policies and practices.

Ecological principles and systems thinking can help to understand and manage complexity for better urban health. But what does this mean in practice? Inter- and trans-disciplinary engagement and careful evaluation of local context are crucial, and ideally lead to support co-creation in cities by diverse sectors of society. Better linked, more complete, and higher-quality data is also needed, spanning many urban sectors, along with local know-how and more informed knowledge about urban ecosystems. Meeting national and city level objectives for health will depends on collaborations that transcend the health sector. Global agreements such as the UN 2030 Agenda for Sustainable Development, the New Urban Agenda, also depend on such integrative approaches beyond the health sector.

We already know:  The ‘health lens’ of city planning and urban governance, endorsed by the WHO healthy Cities project, has been applied in many cities around the world. The co-benefits of explicitly coordinating across sectors, such as housing, energy, land-use and transport has been proposed but not widely adopted. We find that systems thinking across sectors is rarely taught in education and training, or applied in practice. It is evident that the ever increasing quantity of good quality empirical evidence has proven not to be a catalyst for institutional or professional reforms.

What’s new: We argue for major changes to conventional interpretations of urban health, We must have changes to how urban health challenges are studied by researchers; to how these challenges are assessed by policy makers, and to how they are addressed by professionals in different sectors. The request for a trans-disciplinary approach is grounded in an ‘historical lens’ that can be traced back to the wisdom of Hippocrates; the wisdom that he applied to interpret health, illness and disease in precise situations. We now need to reclaim and renew these principles as we look forwards to implementing the New Urban Agenda in tandem with initiatives to achieve the Sustainable Development Goals by 2030.

Implications for city policy and practice: Experiences of the complexities of supporting health in cities demonstrate that simplistic public health policies centred on ‘the individual’ are reaching their limit. This calls for a change in direction for urban health policy. For the sake of urban health all those whose actions affect population health in cities need to hear this call. There is an urgent need for reforms to education and training for the wide array of professions whose actions affect health in cities. The medical and health sectors must improve their own knowledge of the limits to biomedical individualism and conventional analysis of environmental health risks; and better understand how to address the complexity that is part of the urban health challenges. Likewise, all built environment professions, and urban public administration at national and local levels need better to understand how through urban complexity, their activities outside the health sectors, impacts on urban health.

Full article: Lessons from Hippocrates for contemporary urban health challenges

Authors: Roderick Lawrence, José Siri and Anthony Capon